Canadian Trends and Projections in Prescription Drug Purchases: 2001–2023

Abstract


 Limited data are available to understand costs and trends over time in the Canadian pharmaceutical market across all sectors. To fill this gap, a retrospective time series analysis of annual prescription drug purchases in Canada between 2001 and 2020 was conducted using data from the IQVIA Canadian Drugstore and Hospital Purchases Audit.
 Spending has grown over the past 2 decades at a steady pace, with annual average growth of 5.3% and 7.1% in the retail and hospital sectors, respectively. Total prescription purchases in 2020 were approximately $32.7 billion, 4.3% higher than in 2019 (3.8% growth in retail, 6.9% in hospital).
 New approvals of specialty and oncology drugs and generic formulations of the top 25 drugs may influence drug purchases in 2021 to 2023.
 Overall drug purchases in Canada are projected to continue growing. The forecast for the outpatient sector is continued moderate levels of growth in drug spending (3% to 4%), with higher rates of growth (7% to 8%) in the hospital setting.
 Action should be taken to curb sustained growth in pharmaceutical spending in Canada. Otherwise, these costs may be shifted to other budgets, private industry, and/or patients.

Trends in Canadian prescription drug purchasing: 2001–2020

“…Other policy options include reduced entry costs of biosimilars, adjusting incentives embedded in payment policies, and revisiting allowable contracting strategies for biologics [ 9 ]. In coming years, Tadrous et al [ 3 ] predicts downward pressure on spending due to generic formulations (e.g., recently available/forthcoming generic formulations for apixaban and rivaroxaban) and biosimilars (e.g., the biosimilar formulation for adalimumab approved by Health Canada in 2020 which was number 2 in outpatient spending). But given the increases in spending on biologic agents over the last 20 years, it is unlikely that current cost-control mechanisms will be sufficient.…”

“…Outside of the public sector, spending by private insurers was $12.7 billion, with the remaining $6.8 billion paid for by Canadian households [ 2 as cited in 1 ]. Prescription drug spending is estimated to increase from 4.2% to 4.6% per year from 2021 to 2023, for total spending of approximately $37.2 billion in 2023 [ 3 ]. Often, estimates of public spending on prescription drugs do not include drugs dispensed in hospitals or those funded outside of public drug plans such as provincial programs [ 1 ].…”

“…Often, estimates of public spending on prescription drugs do not include drugs dispensed in hospitals or those funded outside of public drug plans such as provincial programs [ 1 ]. Available estimates of drug spending in Canada often focus on payer-specific outpatient expenditures, neglecting inpatient drug spending [ 3 ]. Tadrous et al [ 3 ] demonstrated that not only are the trajectories of spending different in the outpatient and inpatient setting but that the lack of attentiveness to the inpatient setting has resulted in larger relative increases in the inpatient expenditure over time compared to the growth in outpatient expenditure.…”

“…The American Society of Health System Pharmacists (ASHP) guidelines suggest that a first step in managing costs of medications should be to collect and review drug purchase data, focusing on high-priority agents [ 4 ]. Recently, Tadrous et al [ 3 ] described how spending on the top 25 drugs accounted for 52.9% and 26.0% of total spending in outpatient and inpatient sectors, respectively. In order to begin to manage the costs of medications, high-priority agents must be identified.…”

Electronic Health Records to Rapidly Assess Biosimilar Uptake: An Example Using Insulin Glargine in a Large U.S. Nursing Home Cohort

“…A major area in drug policy is the use of biosimilars ( Stern et al, 2021 ). Biologic medications make up approximately half of the expenditures for the top 25 drugs in the US and Canada ( Tadrous et al, 2021 ; Tichy et al, 2021 ), with increasing costs each year. Thus, biosimilar use has the potential to result in substantial healthcare cost reductions.…”